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| 颈总动脉峰值血流速度变异率对休克患者容量反应性的预测价值 |
| Prediction of volume responsiveness in patients with shock using peak variability of carotid blood flow velocity |
| 投稿时间：2018-07-21 |
| DOI：10.3969/j.issn.1000-0399.2018.11.004 |
| 中文关键词: 休克 床旁超声 容量负荷试验 |
| 英文关键词: Shock Bedside ultrasound Capacity load test |
| 基金项目:国家临床重点专科建设项目（项目编号：2011-1563） |
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| 中文摘要: |
| 目的 探讨床旁超声测量颈总动脉峰值血流速变异率（ΔVpeak-CCA）对休克患者容量状态评估的准确性和可行性。方法 对2017年6~12月安徽省立医院重症加强治疗病房（ICU）收治的50例行机械通气且存在自主呼吸的休克患者进行容量负荷试验，根据评估容量反应性金标准每搏量增加值（ΔSV）将患者分成有反应组（R组，ΔSV≥15%）24例和无反应组（NR组，ΔSV<15%）26例。通过床旁超声技术获得所有患者的ΔVpeak-CCA。比较两组患者ΔSV和ΔVpeak-CCA的差异，采用Pearson相关分析ΔVpeak-CCA与ΔSV的相关性，通过受试者工作特征曲线（ROC曲线）评价容量负荷试验前ΔVpeak-CCA预测容量反应性的临床价值。结果 R组患者的ΔVpeak-CCA和ΔSV分别为（13.8±1.9）%和（20.6±4.4）%；NR组患者的ΔVpeak-CCA和ΔSV分别为（8.3±2.7）%和（8.2±3.7）%。R组的ΔSV和ΔVpeak-CCA均高于NR组，差异有统计学意义（P均<0.05）。Pearson相关分析显示两组患者的ΔVpeak-CCA与ΔSV高度相关（r=0.919，P<0.001）。ROC曲线显示：ΔVpeak-CCA判断休克患者容量反应性的诊断阈值为12.1%，灵敏度为95.8%，特异度为73.1%，曲线下面积为0.921。结论 ΔVpeak-CCA可以准确预测ICU中机械通气且存在自主呼吸的休克患者液体治疗时的容量反应性，该操作简单易行，值得推广。 |
| 英文摘要: |
| Objective To investigate the accuracy and feasibility of bedside ultrasound measuring peak velocity variation (ΔVpeak-CCA) in the common carotid artery when assessing the capacity status of shock patients. Methods The capacity load test was conducted in 50 shock patients with mechanical ventilation and spontaneous breathing in Intensive Care Unit of our hospital from June to Dec 2017. According to the stroke volume increment which showed the response to the volume-load test, the patients were divided into the response group (R group, ΔSV ≥ 15%) and the non-response group (NR group, ΔSV<15%). ΔVpeak-CCA was obtained by the ultrasonic measurement before the volume-load test. The difference between the ΔSV and ΔVpeak-CCA was compared. Pearson correlation analysis was used to assess the correlation between ΔVpeak-CCA and Δ SV. The receiver-operating characteristic curve (ROC curve) was used to evaluate the clinical application value of Δ Vpeak-CCA before evaluation experiment when predicting the volume status and fluid responsiveness. Results The average value of ΔVpeak-CCA and ΔSV for 24 patients in R group was respectively (13.8±1.9)% and (13.8±4.4)%, while the above data obtained from NR group (n=26) were (8.3±2.7)% and (8.3±3.7)%, respectively. ΔSV and ΔVpeak-CCA in R group were significantly higher than those in NR group, and the difference was statistically significant (P<0.05). Pearson correlation analysis showed that there was a high correlation between ΔVpeak-CCA and ΔSV (R=0.919,P<0.001). Moreover, ROC curve showed that ΔVpeak-CCA measured by ultrasonometry had high clinical application value in the diagnosis of shock (AUC=0.921, the threshold value=12.1%, sensitivity was 95.8%, specific degree was 73.1%). Conclusion ΔVpeak-CCA can accurately predict the volume status and fluid responsiveness for shock patients with mechanical ventilation and spontaneous breathing. Moreover, it is easy for operation and thus suitable for promotion. |
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